Salvage repair of rare iatrogenic bilateral ureteral injury after hysterectomy

Abstract

Ureteric injury is a well-documented complication of gynecological surgery, however, bilateral ureteric injuries are rarely encountered and there is no consensus on the management of such complex injuries. We present our successful management of iatrogenic bilateral ureteric injuries in a patient after failed primary endourological surgery and attempted open repair. Our patient is a thirty-five years-old woman who sustained bilateral ureteral injury after open radical hysterectomy to treat a squamous cell carcinoma of her uterus. She subsequently became reliant on bilateral ureteral stents following a failed open surgical repair of her left ureter. Upon evaluation, retrograde pyelogram showed bilateral ureteral strictures with hydronephrosis and ureteroscope could not be passed beyond the tight strictures in the ureters following removal of double-J stents. Open bilateral repair of ureters aims to achieve tension-free bilateral ureteroneocystostomies with a unilateral right psoas hitch. We discussed the adaptations of conventional technique involving tunneling of the left ureter underneath the sigmoid mesentery. She recovered well and was stable on discharge. Upon follow-up in clinic one year later, hydronephrosis resolved completely with conserved renal function. Therefore, we demonstrated and outlined the principles in our successful approach and showed that it is feasible to treat bilateral ureteral injuries following hysterectomy with open repair in spite of unsuccessful primary endourological surgery and attempted open repair.